Immunotherapy in asthma

Abstract

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. Chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, as well as variable airflow obstruction within the lung. With time, such airflow obstruction may become permanent due to remodeling. It has been treated for more than 100 years by subcutaneous immunotherapy with allergen extracts but in recent years, other forms and types of immunotherapy have been introduced. Perhaps the most successful of these to date, is sublingual immunotherapy, which has attained significant usage in European countries but has yet to make inroads into clinical practice in North America. Other mechanisms to modify the inflammatory responses of asthma have included immunotherapy with recombinant allergens, the use of allergen peptides targeting antigen-specific T cells and the administration of Toll-like receptor agonists coupled to allergen proteins. As the inflammatory responses in asthma frequently involve IgE, a modified monoclonal antibody to IgE and interfering with its binding to the IgE receptor have gained acceptance for treating severe allergic asthma. Other monoclonal antibodies or recombinant receptor antagonists are being assessed for their ability to block other contributors to the inflammatory response. Finally, attempts have been made to generate autoantibody responses to cytokines implicated in asthma. Most of these therapies aim to modify or inhibit the so-called Th 2 immune response, which is implicated in many forms of asthma, or to inhibit cytokines involved in these responses. However, an added benefit of classical immunotherapy seems to be the ability to prevent the allergic progression to new sensitivities and new forms of allergic disease.

Research needs in allergy: an EAACI position paper, in collaboration with EFA

“…Accumulating evidence have convincingly shown that in addition to alleviating symptoms, allergen specific immunotherapy can improve quality of life, reduce long-term costs and burden of allergies, and has the potential to change the course of the disease. Several appropriately designed and powered clinical trials have proven its good safety profile and effectiveness in allergic rhinitis, asthma and venom allergy [59,136,137]. …”

Ragweed Pollen Allergy: Burden, Characteristics, and Management of an Imported Allergen Source in Europe

“…The first improvement of ragweed AIT was the use of adjuvants (e.g., aluminum hydroxide, calcium phosphate, or tyrosine) and the chemical modification of extracts (allergoids), which lowered the risk of systemic side effects and enabled the faster achievement of the maintenance dose in comparison with aqueous extracts [98]. New adjuvants, such as monophosphoryl lipid A, the non-pyrogenic component of Salmonella minnesota LPS, combined with ragweed allergoid adsorbed to L-tyrosine, in order to boost its immunogenicity, are currently available [99, 100].…”

Asthme : quelle place pour l’homéopathie (1re partie)

“…Après stabilisation du patient, il sera possible de diminuer la corticothérapie inhalée par paliers de 25 à 50 % sur trois mois. D'autres thérapeutiques peuvent être utilisées : en premier lieu, la désensibilisation [13], qui a bénéficié de la voie sublinguale : elle peut être efficace dans les cas l'allergie aux acariens, spores de moisissures, ainsi qu'aux pollens et phanères d'animaux ; la kinésithérapie, l'exercice physique (natation) ; les traitements de terrain : thermalisme, homéopathie, acupuncture, oligo-éléments, phytothérapie ;…”

“…des traitements nouveaux dans les asthmes sévères : antiIgE (omalizumab), anticorps monoclonaux anticytokines anti-IL4, anti-IL5, et anti-TNF [13].…”